Does weed help seizures
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The Role of Cannabis in Treating Seizures
Introduction to Cannabis and Epilepsy
Epilepsy is a neurological disorder characterized by recurrent seizures, affecting millions worldwide. Traditional antiepileptic drugs (AEDs) are often effective, but approximately one-third of patients have treatment-resistant epilepsy (TRE), necessitating alternative therapies. Cannabis, particularly cannabidiol (CBD), has emerged as a potential treatment for epilepsy, with growing evidence supporting its efficacy.
Cannabidiol (CBD) and Seizure Reduction
Clinical Trials and Efficacy
Recent studies have shown that CBD, a non-psychoactive component of cannabis, can significantly reduce seizure frequency in patients with epilepsy. In randomized controlled trials (RCTs) involving children with Dravet syndrome and Lennox-Gastaut syndrome, CBD produced a 38% to 41% median reduction in seizures compared to 13% to 19% with placebo1 5. Additionally, CBD demonstrated a 39% to 46% responder rate (50% convulsive or drop-seizure reduction) compared to 14% to 27% on placebo5.
Mechanisms of Action
The exact mechanisms by which CBD exerts its anticonvulsant effects are not fully understood. However, it is known that CBD does not act via traditional cannabinoid receptors (CB1 and CB2). Instead, it may modulate various other receptors and channels, including the transient receptor potential of vanilloid type-1 (TRPV1), GPR55, sodium channels, and adenosine receptors3 6. These interactions potentially contribute to its ability to reduce seizures.
Whole-Plant Cannabis vs. Purified CBD
Comparative Efficacy
While purified CBD has shown promise, some evidence suggests that whole-plant cannabis extracts, which contain a combination of cannabinoids, may be more effective for some patients. For instance, a case study involving a high-CBD strain known as Charlotte's Web significantly reduced seizure frequency in a child with Dravet syndrome, highlighting the potential benefits of whole-plant therapy4.
Safety and Side Effects
CBD is generally well-tolerated, with common side effects including diarrhea, sedation, and decreased appetite5. However, interactions with other medications, such as clobazam and valproate, can increase the risk of adverse effects, necessitating careful monitoring3. Whole-plant cannabis, which includes psychoactive THC, may pose additional risks, including psychoactive effects and potential for abuse2.
Patient Perspectives and Usage
Anecdotal Evidence and Surveys
Despite limited high-quality evidence, many patients with epilepsy report using cannabis to manage their seizures. A survey conducted at a tertiary care epilepsy center found that 21% of patients had used marijuana in the past year, with the majority reporting beneficial effects on seizures8. This highlights the significant interest and perceived efficacy of cannabis among epilepsy patients.
Systematic Reviews and Observational Studies
Systematic reviews and observational studies further support the potential benefits of CBD for epilepsy. A review of 36 studies, including RCTs and observational studies, found that CBD was more effective than placebo in reducing seizure frequency and improving quality of life, although it also increased the risk of adverse events7.
Conclusion
Cannabis, particularly CBD, shows promise as a treatment for epilepsy, especially in patients with treatment-resistant forms of the disorder. While purified CBD has demonstrated significant efficacy in clinical trials, whole-plant cannabis extracts may offer additional benefits for some patients. However, the safety profile and potential drug interactions of cannabis-based therapies necessitate careful consideration and further research. As our understanding of the mechanisms underlying CBD's anticonvulsant effects grows, it may pave the way for more effective and safer treatments for epilepsy.
Sources and full results
Most relevant research papers on this topic
Cannabis based drug shows promise in children with resistant epilepsy
Cannabidiol, a cannabis-based drug, shows promising results in treating Dravet syndrome in children unresponsive to existing drugs.
RCT
Very Rigorous JournalCannabinoids and Epilepsy
CBD shows promise as a well-tolerated, promising therapeutic for treating seizures in epilepsy, while whole-plant cannabis can both contribute to and reduce seizures.
Literature ReviewVery Rigorous Journal
Highly CitedCannabis for the Treatment of Epilepsy: an Update
CBD, a non-psychoactive component of cannabis, shows potential in reducing seizure frequency in patients with various types of epilepsy, but may interact with certain medications.
Literature ReviewHighly CitedThe case for medical marijuana in epilepsy
Medical marijuana, specifically CBD:THC, can effectively reduce seizure frequency in children with epilepsy, potentially benefiting those with severe forms of the condition.
Case ReportHighly CitedEfficacy of cannabinoids in paediatric epilepsy
CBD shows similar efficacy to established antiepileptic drugs in reducing seizures in children with Dravet syndrome and Lennox-Gastaut syndrome, with well-tolerated side effects.
RCTVery Rigorous JournalThe Pharmacological Basis of Cannabis Therapy for Epilepsy
Cannabis therapy, primarily CBD, shows potential as an alternative treatment for refractory epilepsy, but the exact mechanisms underlying its anticonvulsant efficacy remain unclear.
Highly CitedEvidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence
Cannabidiol (CBD) may reduce seizure frequency and improve quality of life in treatment-resistant epilepsy patients, but increased risk of adverse events and serious adverse events warrants further research.
Systematic Review
Rigorous JournalHighly CitedMarijuana use and epilepsy
Many patients with epilepsy believe marijuana is an effective therapy and actively use it despite limited evidence of efficacy.
Observational StudyCannabigerolic acid, a major biosynthetic precursor molecule in cannabis, exhibits divergent effects on seizures in mouse models of epilepsy
Cannabigerolic acid, a major component in cannabis, shows diverse effects on seizures in epilepsy mouse models, suggesting other cannabis constituents may have anticonvulsant properties.
Very Rigorous JournalEvaluating the Efficacy of Cannabinoids in Epilepsy: A Critical Examination of Hard Evidence
Cannabinoids, particularly CBD, show potential in managing seizures and improving seizure control in epilepsy patients.
Systematic Review